The business model depends on folks like associate Kathy Miller closing a sale, without taking a breath, from the company’s call center: "You get a free gift today it's a pair of knee highs and your total includes the merchandise, postage and handling and the replacement fee so it will come to $37.97 and I completed your order so you're all set."

Among the things that go into that 8 percent are a handful of fees and taxes that help pay for the health law. In exchange, consumers gain benefits like certain guaranteed benefits and improved coverage.

AmeriMark, like most businesses, has been coping with rising health insurance premiums for years. This year, the company’s initial estimate from a broker was a 30 percent increase in premium prices if they stayed with the same insurance provider. Lyons said they shopped around, chose a new company and altered benefits, including increasing the deductibles and co-pays. Such changes in plans have become increasingly common nationally as annual increases in health care premiums have become normal.

For many medium-sized companies, like AmeriMark, the new costs of the Affordable Care Act are an added burden on top of the health insurance premiums that have been rising for years. The largest of the new Obamacare costs, is the health insurance provider tax (HIT). It’s a tax that the federal government charges insurance companies and the size of the fee depends on how many people are being covered.